It takes an enormous amount of effort to keep you and your family healthy. Morning vitamins, nutritious meals, daily exercise, annual checkups, necessary prescriptions—it all adds up in a way that can make thinking about anything else health care-related just a little too taxing.

But here’s the thing: Being informed about what’s happening in Colorado’s medical community is critical to your family’s health, albeit in a big-picture way. For example, what would you do if you thought your child might be sensitive to gluten? Or what if your dad needed help losing weight? Or what if you could assist with breast cancer research without having to write a check? Or what would you do to help your child monitor his diabetes when he goes to college? Would you know where to go or who to see in Denver (and beyond) in these situations? No? No problem. We know it’s difficult to keep up with everything you’d want to know, so we’ve done it for you. The stories on the following pages will show you what you haven’t had time to discover for yourself.

5280 August 2015
More From The Issue

Drawing The Short Straw

Let’s just put this one in the that’s-totally-unfair category: About 80 percent of the estimated 23.5 million Americans with autoimmune disorders (think: lupus, rheumatoid arthritis, and celiac disease) are women. Why the gender gap? That’s what Kira Rubtsova, Philippa Marrack, and Anatoly V. Rubtsov at National Jewish Health’s Department of Biomedical Research are on a quest to discover. Partially funded by two U.S. Public Health Service grants, the team has spent six years figuring out why women are getting these incurable diseases—and what medical researchers can do about it. Here’s a quick glance at their crusade:

The question: What causes autoimmune disorders, and why do they occur more frequently in women?

The hypothesis: Having two X chromosomes and reproductive hormones can disrupt a woman’s healthy immune system.

Aha! moment: While looking at the X chromosome genes in healthy male and female mice during a research trial that began in 2009, the team noticed a previously unobserved type of cell—now called ABCs, or age-associated B cells. These cells are present in healthy female (but not male) mice, and they proliferate in female mice as they age. Researchers also found higher levels of ABCs in young and old mice that were predisposed to autoimmune disorders. Large accumulations of these age-associated B cells also can be found in human autoimmune disorder patients.

What now? The research team has successfully stopped the accumulation of ABCs in a mouse trial and hopes to develop a drug that replicates that intensive process on a larger scale to remove the cells before autoimmune disorders develop.

What this means for you: While human trials are likely more than a decade away, the ABCs discovery offers hope for early detection and prevention of autoimmune disorders, particularly for women. “The female immune system is stronger than the male immune system,” Rubtsova says. “This makes sense because the female body has to take care of the progeny. It’s possible that the stronger immune system triggers an autoimmune response.” It may also explain why males seem to whine more about the common cold. —Natasha Gardner

Extra Sensitive

We all know what it feels like when food doesn’t agree with us—but having celiac disease is different.

Courtesy of iStock

With all the gluten-free items on the market these days, it’d be easy to think that almost everyone you encounter has a problem digesting her morning toast. The thing is, celiac disease—a genetic autoimmune disorder that damages the small intestines and prevents absorption of nutrients from food—really is pretty common. About 2.4 million Americans, or about one in every 133 people, have the disorder. In fact, the incidence of the disease—triggered by ingestion of the protein gluten, which is found in wheat, barley, and rye—has increased four-fold in the past 50 years. Greater awareness and improved testing methods cannot fully account for the explosion, leaving researchers scratching their heads. “What we do know,” says Dr. Edwin Liu, director of the 14-month-old Colorado Center for Celiac Disease (CCCD) at Children’s Hospital Colorado, “is this is a widely misunderstood disorder, for as common as it is.” Which is why Liu believes the CCCD, the first and only center of its kind in the Rocky Mountain region, is such a critical resource. Not only does the center excel at diagnosing and confirming the disorder in youngsters (it often develops in childhood and can stunt growth and development), it also provides the continuing medical care, nutrition classes, and social support families need to care for their newly gluten-free kid. “There is no medical treatment for celiac disease,” Liu says. “A strict and lifelong gluten-free diet is the treatment. And as trendy as it’s become to be gluten-free, it’s not an easy thing to manage on your own. We can hold a patient’s hand through the steep learning curve.” —LBK

The percentage of Colorado kindergartners who were fully vaccinated against the measles during the 2013-2014 school year, ranking the Centennial State dead last among 49 states and the District of Columbia (stats for Wyoming were not available). The issue of immunizations garnered national attention last year when an outbreak of vaccine-preventable measles that began in California—and moved to multiple states, including Colorado—sickened dozens of people.

Colorado’s lousy vaccination rates are partly attributable to high exemption rates: The state is one of 20 that allow parents to opt their children out of immunizations for any reason. The problem with that? Experts say that once the vaccination rate drops below 95 percent, the population loses its “herd immunity,” which can be a huge problem for people who cannot get vaccines because of allergies or suppressed immune systems. It’s not difficult to imagine that Colorado’s inability to raise its immunization rates is contributing to a scary situation: 644 cases of measles were reported in 27 states in 2014—14 years after the illness was declared eliminated from the United States. —LBK

Virtual Reality

New telemedicine initiatives are bringing doctors to you.

Illustration by Harry Campbell

Twenty-year-old Eric Thompson wakes up, rolls out of his bunk in his University of Colorado Boulder dorm room, settles onto a futon, and fires up his laptop. Minutes later, the computer science major is face-to-face (via a secure Web video service) with Dr. Jennifer Raymond, his longtime endocrinologist at Children’s Hospital Colorado in Aurora. Raymond has already downloaded data from the insulin pump Thompson uses to manage his Type 1 diabetes; they go over his readings before transitioning to a group-chat screen, where Thompson can talk with other patients his age about how they’re dealing with challenges such as the college late-night food scene. Less than an hour later, Thompson’s off to meet his friends for lunch at the dining hall.

Before Children’s grant-funded CoYoT1 (Community-based Young-adult Type 1 Diabetes) Management Program, Thompson had to block out half a day to come to the hospital for quarterly visits. For newly independent young adults juggling classes, part-time jobs, and busy social lives, that can be a big ask. “We found that 18- to 25-year-olds just didn’t come,” Raymond says, explaining that mismanaged diabetes at this age can lead to lifelong complications. “So we thought maybe we could meet them where they are.” Since the first-of-its-kind CoYoT1 program launched this past spring, not one of Raymond’s patients has missed a clinic appointment.

Children’s is seeing similar outcomes across 54 other initiatives that leverage technology to deliver care remotely, a trend called telemedicine. Video conferencing for psychiatric evaluations, for example, has reduced the transfer rate (meaning the doctor asks the patient to come in for examination, sometimes from hours away) from 93 percent to 10 percent. Raymond hopes numbers like these—and their associated cost savings—will encourage Colorado to go beyond House Bill 1029, which was signed by Governor John Hickenlooper in March. That law expanded services by requiring public and private insurers to reimburse health-care providers for telemedicine services delivered at approved sites in both rural and urban areas. For programs like CoYoT1 to be covered, however, the Centennial State would need to join a handful of other states that have removed the “approved site” requirement—effectively turning coffeeshops, libraries, and, yes, even dorms into exam rooms. —Jessica LaRusso

Battling the Bulge

From top: courtesy of Dale Robinson; courtesy of ABC EWL

Since 2014, ABC’s Extreme Weight Loss docuseries has begun its seasons at the University of Colorado Anschutz Health and Wellness Center, where Dr. Holly Wyatt ensures contestants can handle the show’s regimen. Wyatt says the show does a great job of inspiring people, but she wondered, What’s next? With that in mind, the center launched Extreme Weight Loss: Destination Boot Camp in 2014. Participants attend a weeklong lifestyle camp at CU before completing a yearlong online program at home. Dale Robinson, 60, attended CU’s first class. Here, she explains her experience.

 “I watched Extreme Weight Loss and was in awe of the people losing weight. At the end of one show, they advertised the Destination Boot Camp at Anschutz. I am five feet five inches tall and weighed 342 pounds when I signed up. My goal weight was 171 pounds. I had done other weight-loss shows’ boot camps. They put you through six hours of exercise a day, so you lose good weight, but when you went home you were on your own. So I quit. I quit so many times. Anschutz doesn’t beat the heck out of you during the week you’re there. The days are long, and you work out a few hours daily, but it’s more about changing your mindset than your waistline. You journal, meet with psychologists, and learn how to cook with high-protein meat and complex carbohydrates, especially veggies. The goal isn’t to get a bunch of weight off you—it’s to prepare you to go home. When you do go home, you meet with your coach and teammates once a week online. The coach assigns homework, such as making a motivational board. On mine, I put the seat-belt extender I used on airplanes. It’s a reminder of how embarrassing that was. After 11 months, I was down to 180 pounds—I haven’t been below 200 since my 20s. I’m not worried about gaining it back, but to make sure I don’t, I wear bracelets that say, ‘Choose your hard.’ When exercise or eating right gets hard, I remember what it felt like to be overweight: no concerts, no ball games, personal hygiene became tough. I don’t want that kind of hard ever again.” —as told to Spencer Campbell

Off Label

Building up your immune system is a good thing, right? Maybe not, if you are one of the more than 9,700 people in Colorado estimated to be fighting multiple sclerosis (MS), a disease in which the immune system attacks the nervous system. Researchers don’t know what causes MS, why so many Coloradans are impacted (the state has one of the highest rates in the country), or how to cure it, but they do think the immune system could be the key. If we know why—or when—the immune system goes from protecting the body to attacking it, perhaps we can prevent or cure the disease. That’s what prompted Dr. Richard Nash, a hematologist at the Colorado Blood Cancer Institute at Presbyterian/St. Luke’s Medical Center, to undertake a five-year, phase 2 clinical trial (partially completed in 2014) on patients with advanced MS, using techniques he learned fighting cancer. “This trial is evidence,” Nash says, “that immunosuppression is beneficial.”

The big question: If an immune system is destroyed—using the chemotherapy perfected in blood cancer treatments—and rebuilt using a patient’s stem cells, will the new immune system be less prone to attack the nervous system, thus halting MS?

Who was included in the trial: Twenty-four people with severe relapsing-remitting MS—a common form of the disease in which a person has attacks separated
by periods of improved or consistent health—who had not responded to other treatments.

The risk: High. The patients’ immune systems were obliterated, meaning that they were highly susceptible to infection, especially in the first six months.

The results: Promising. Seventy-eight percent of patients were free from disease activity—meaning there were no measurable attacks on the brain—for three years.

Next steps: Nash is securing funding and approval for a multiyear, randomized clinical study to confirm the trial’s findings.

What it could mean for patients: This treatment, should it get FDA approval for treatment of MS, would likely be reserved, at least initially, for those experiencing advanced stages of MS. But the research behind it could further our understanding of why the immune system helps stop or start MS attacks. —NG

The number of ongoing clinical trials for melanoma at the Cutaneous Oncology Clinic at the Anschutz Cancer Pavilion. National numbers suggest the lifetime risk for Americans of getting melanoma—a deadly form of skin cancer—is about 1 in 50. In Colorado, where a high UV index and an outdoorsy population increase sun exposure, the chances are even higher. Which is why Dr. Karl Lewis, a medical oncologist, is researching new ways to battle a disease that, until recently, had zero treatments that extended life expectancy. Fortunately, that’s not the case any longer. In the past half-decade, scientists have learned that about half of melanoma patients have a mutation in their cancers called BRAF, which can be treated with drugs approved in 2011 and ’13. Scientists also have made progress using immunotherapy, which encourages the immune system to attack the cancer. These novel treatments have moved the needle on life expectancies for some patients, but melanoma often becomes resistant to BRAF blockers, sometimes as quickly as six months after starting the drugs. “Delaying resistance is what some of the trials we’re participating in look at,” Lewis says. “We’re examining whether medicines used in combination can help, and we’re also trying different doses and different timing of medicines to see if we can, as a long-term goal, turn melanoma into a chronic disease instead of a death sentence.” —LBK

Checkup: To set up an appointment with a specialist at the Cutaneous Oncology Clinic, call 720-848-0505.

High Inquiry

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Until this year, California was the only state funding medical marijuana research, a difficult endeavor given the drug’s federal status as a Schedule I substance. Now, Colorado has become the second state to throw money at the issue. In 2014 and 2015, the Board of Health OK’d spending $9 million on a handful of medical cannabis studies. In February, nine grant recipients were selected, and some of them are beginning their research this summer. Here, a look of what several of these scientists will be studying. —Kasey Cordell

Research: Inflammatory Bowel Disease
Primary Investigator and Research Institution: Edward J. Hoffenberg, University of Colorado Anschutz Medical Campus
About the Study: Hoffenberg and his team are conducting what’s known as an observational study: They don’t provide patients with any marijuana; they simply track patients who are already using it on their own. In this case, Hoffenberg will follow young adults (ages 13 to 23) who suffer from inflammatory bowel disease to see if patients report improvement in their symptoms. Researchers will track frequency of use and type of marijuana being consumed as well as measure tetrahydrocannabinol (THC) and cannabidiol (CBD) levels in the blood.
Grant Amount: $1,191,329

Research: Parkinson’s Disease
Primary Investigator and Research Institution: Maureen A. Leehey, University of Colorado Anschutz Medical Campus
About the Study: Leehey hopes to determine if CBD can help reduce tremors in Parkinson’s patients. One of the few studies in which researchers will give patients marijuana, the project will monitor how the drug affects anxiety, sleep, and psychotic symptoms.
Grant Amount: $1,028,981

Research: Post-Traumatic Stress Disorder
Primary Investigator and Research Institution: Marcel O. Bonn-Miller, University of Pennsylvania School of Medicine*
About the Study: In this Colorado-based observational study, Bonn-Miller will follow 150 subjects who suffer from PTSD, half of whom use marijuana to ameliorate symptoms. The team will track benefits, negative effects, and sleep patterns. The team will also regularly test the strains of marijuana the patients are using to assess differences.
Grant Amount: $1,181,127

Research: Pediatric Brain Tumors
Primary Investigator and Research Institution: Nick Foreman, University of Colorado Anschutz Medical Campus
About the Study: Foreman’s observational study isn’t attempting to determine if marijuana can cure brain tumors. His team is investigating how cannabis functions as a palliative treatment in young people with brain tumors. Foreman will track 150 children (from infants to 18-year-olds) to examine a number of measurables: CBD, THC, and other marijuana metabolite levels in the blood; the effect of the drug on immune cell function; and how successful cannabis is at treating side effects of cancer treatments, such as anxiety and nausea.
Grant Amount: $1,041,256

Research: Chronic Pain
Primary Investigator and Research Institution: Emily Lindley, University of Colorado Anschutz Medical Campus
About the Study: Lindley hopes to better understand the effectiveness of cannabis versus oxycodone as an analgesic by administering both, as well as a placebo, to patients suffering from chronic back and neck pain. Lindley’s is one of the few studies in which physician-researchers will provide patients with marijuana.
Grant Amount: $743,122

Research: Pediatric Epilepsy
Primary Investigator and Research Institution: Kelly Knupp, University of Colorado Anschutz Medical Campus
About the Study: Using EEGs (which measure electrical activity in the brain), seizure diaries, and bloodwork, Knupp will follow 110 children with poorly controlled seizure disorders to determine if the drug helps improve the frequency and severity of their seizures. Researchers will not provide the children with marijuana but will observe those patients already taking it on their own.
Grant Amount: $631,835

Research: Sleep Disorders
Primary Investigator and Research Institution: Russell Bowler, National Jewish Health
About the Study: Using home sleep-study units and interviews, Bowler hopes to learn how marijuana affects insomnia and sleep quality—including type of sleep, how often patients wake up, and respiratory issues—in adults with sleep disorders. The observational study is part of the Colorado Cannabis Cohort’s tracking of cannabis users to better understand the long-term effects of marijuana on sleep.
Grant Amount: $450,000

Group Project

Cancer can’t be solved by one institution alone, which is why CU’s cancer center joined an elite alliance of oncology researchers in 2015.

Illustration by Harry Campbell

It’s difficult to overstate the impact that precision medicine—an emerging approach to disease treatment and prevention that takes into consideration genetics, environmental factors, and lifestyle choices for each person—could have on nearly every malady known to man. It might have huge implications for everything from heart and lung disease to diabetes. Right now, though, the tactic is being used most effectively in oncology; scientists are discovering how to identify genetic mutations in cancer cells and (sometimes) treat patients with so-called targeted therapy drugs. But here’s a hiccup: While researchers now have data about the genetics of cancer, the problem is identifying the genes causing cancer to grow and finding drugs to block those genes. As such, the University of Colorado Cancer Center has recently become one of seven facilities in the country that have partnered to create ORIEN (Oncology Research Information Exchange Network), an alliance of institutions that will share big data for the purposes of cancer research. What does that mean? We spoke with Dr. Dan Theodorescu, director of the CU Cancer Center, to find out. —LBK

5280: This sounds like a great idea—was it yours?

Dr. Theodorescu: I was one of the early supporters of ORIEN. The vision for it started six or seven years ago, but ORIEN truly was born about a year ago. The University of Colorado Cancer Center joined the group in February.

Why will ORIEN be such a powerful tool?
We’ve learned that cancer is a genetic disease. That means if you can look at the molecular profiles of patients’ cancers, you can begin to group them together and do clinical trials. For example, if you are a large pharmaceutical company and you think you have a drug that may target a genetic mutation of breast cancer, you need to find enough patients with breast cancer with that mutation to put together a clinical trial. ORIEN will facilitate doing clinical trials with targeted drugs against specific mutations.

How does ORIEN identify those patients?
This is really what ORIEN is—it’s a data warehouse. Each time a new cancer patient walks through the doors at any of the ORIEN institutions, he or she can consent to having his or her clinical and genetic information and tissue sample collected. That information—hopefully derived from several thousand consenting volunteers each year—is stored at Moffitt Cancer Center, where it can be accessed by researchers at ORIEN member institution to find new biomarkers and drug targets.

So ORIEN can help cancer patients in real time?
Yes. Historically, data collection has been stripped of patient information, meaning I could work with the information, but I had no idea who the person was. ORIEN’s data is de-identified for research purposes, but because these patients consented, we can go back to them—even years later—if we find a new drug exists for their cancers or if they match a clinical trial. It also helps society as a whole in that it speeds up trials and drug development. These specimens move the field forward.

Candy Crushed

Are we overdoing it on the marijuana edibles?

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Social media hype might make you think marijuana legalization has resulted in a spike in ER visits in Colorado. After all, the state’s foray into recreational sales means that easy access to the drug has folks trying novel delivery methods, like weed-spiked hard candy. It also means pot rookies who don’t know what they’re doing—or kids, who shouldn’t be partaking at all—might get into something best avoided.

The medical reality surrounding recreational marijuana—particularly edibles—is far more complex than those 140-character depictions on Twitter. Although ER personnel say they have witnessed an uptick in marijuana-related visits, no one—not the Colorado Department of Public Health and Environment, nor any local hospitals—has determined the exact numbers statewide. The ER at Children’s Hospital Colorado, which deals mostly with patients under 21, saw 14 marijuana-related admissions out of more than 70,000 patient visits in 2014, up from eight in 2013. “That number is dwarfed by the patients we see for alcohol intoxication,” says Dr. Lalit Bajaj, a pediatric emergency medicine physician at Children’s.

In fact, it may be veteran smokers who are running into the most problems with edibles due to their unpredictable potency. Although there’s never been a documented fatality from overconsumption, Colorado has seen several deaths linked to—though not definitively caused by—edible usage. “People are trying things they might not have before,” says Denver Health’s Dr. Christopher Colwell, “and we’re seeing them after some bad decision-making.”

As regulators continue to tweak the rules, the buzzword should be caution. Edible makers such as Cheeba Chews provide instructions with their medical products, which advise customers to start with no more than 10 milligrams of THC per dose and to wait at least 45 minutes before sampling more. Or, as the staff at Denver’s Lotus Medical instructs its customers, “Don’t be a hero.” —Luc Hatlestad

No Smoking

State grant money helps moms-to-be put down the cigarettes—for good.

While many expectant mothers cite pregnancy as their strongest motivator for quitting smoking, about half resume use within six months of delivering. A new tobacco cessation program called Healthy You, Healthy Baby at Lutheran Medical Center, run with a grant from the Colorado Department of Public Health and Environment (CDPHE), may help improve those statistics for moms-to-be and their newborns. Since January 2014, every woman who enters the hospital to deliver a baby has been asked if she has used tobacco in the past 12 months; if the answer is yes, a cessation specialist visits post-delivery and uses motivational interviewing, nicotine replacement therapy if appropriate, referrals to services such as the Colorado Quit Line (1-800-QUIT-NOW, coquitline.org), and a follow-up call six months later to help moms stay away from the cancer sticks. “It’s not a magic thing,” says Emma Goforth, former tobacco cessation supervisor at the CDPHE. “It’s a way of engaging in a dialogue to determine where Mom is at in her motivation, what barriers she might be perceiving about quitting, and building self-confidence around the steps she needs to take.” Though still in its infancy, Healthy You, Healthy Baby has shown enough potential that the CDPHE awarded Lutheran about $200,000 annually for up to three years to extend the program and create a tool kit for other hospitals to use in building their own versions. —Daliah Singer

Outbreak

Is a virus to blame for mystery paralysis in 13 Colorado kids?

If you got a nasty respiratory illness last fall, you weren’t alone. Millions of American lives were interrupted by runny noses, coughing attacks, and difficulty breathing. The culprit? Enterovirus D68 (EV-D68), a bug that’s in the same viral family as poliovirus but wasn’t thought to cause paralysis like its infamous sibling. That is, until 2014, when doctors at Children’s Hospital Colorado began noticing patients exhibiting unexplained weakness.

Pediatric neurologist Dr. Teri Schreiner initially thought some of the kids they were seeing might have transverse myelitis, a neurological disorder caused by inflammation of the spinal cord. But as more children came to the hospital complaining of various weaknesses, Schreiner, as well as pediatric infectious disease specialists Dr. Kevin Messacar and Dr. Samuel Dominguez, began to believe there was something distinct about the illness. “All of their MRIs were atypical but nonspecific,” Schreiner says, “and all of them described weakness appearing three to 16 days after a respiratory illness.”

After notifying the Colorado Department of Public Health and Environment, they called the CDC with a scary statement: We think we have an outbreak. In a span of just a few months, doctors at Children’s had seen 12 affected kids (another was admitted at Denver Health), and ultimately 118 American children with similar symptoms were identified, some of whom experienced facial drooping, difficulty swallowing, and paralysis of arms and/or legs. With rehab, some children improved, but others sustained permanent damage to motor neurons in the brain stem and spinal cord. “We became suspicious this damage was caused by a virus,” Messacar says. “With the unprecedented outbreak of EV-D68 happening simultaneously, we thought a link was plausible.” But it was difficult to prove. Only 50 percent of the afflicted children had evidence of having had EV-D68. The others didn’t.

“That doesn’t mean they didn’t have it at one time,” Schreiner says. “The body clears the virus quickly, so it’s possible we missed the window.” Children’s docs aren’t big on missing anything, though, which is why they’re working with researchers to determine if there’s an association between EV-D68 and paralysis. “There have been studies looking at the virus to see if it’s different from previous outbreaks of EV-D68,” says Dominguez, explaining early results suggest it is. “There are also studies looking into whether certain children’s genes make them susceptible to paralysis.”

Doctors at Children’s are also learning from the original 12 patients through a special clinic, where a medical team assesses them. “It’s been great to be able to document their progress and collect vital information,” Schreiner says.

“It could help us understand future outbreaks.”

Which is the question on everyone’s mind as enterovirus season begins this month. “We have no crystal ball to tell us if EV-D68 will be around in 2015,” Dominguez says. “But we’re working hard to figure out if it was the cause of the paralysis.”

The more you know

If EV-D68 is linked to paralysis, prevention is key. Washing your hands, wiping down surfaces, and covering your mouth when you cough are critical measures to take. It’s important to understand, though, that not every kid who gets a cough this fall will be paralyzed. Only 13 kids in the state (out of thousands who were sick with respiratory illnesses) reported weakness. However, if your child has a fever for multiple days, is having difficulty breathing, or says he has muscle weakness, visit your doctor. —LBK

Dan Saelinger / Trunk Archive

Expecting?

If so, you could gain good karma by assisting breast cancer research.

Ready to feel better about humanity? In what could easily be considered the most feel-good clinical trial going on in the state right now, healthy women who are pregnant or breast-feeding a newborn are taking time out of their busy lives to help the 13,000 to 14,000 U.S. women who are diagnosed with pregnancy-associated breast cancer each year. The research, directed by Dr. Virginia Borges at the University of Colorado Cancer Center, focuses on how scientists might prevent pregnancy-associated breast cancer—an unusually aggressive and deadly iteration of the disease—by studying postpartum breast involution. Involution is the process by which the breast regresses to a non-milk-secreting state and is known to make breast tumors worse. “We know involution moves cancer along,” Borges says, “but we’ve only seen it in the lab. We needed to study involution in real women who are living real lives.” Hence, the clinical study, which began in 2013 and will run through 2017. The study asks women to submit to questioning and a one-time breast-tissue biopsy. Borges hopes the information and tissue samples will help her determine if taking a drug at a certain stage of involution, for a certain length of time, could prevent breast cancer from arising altogether or at least make the tumors less aggressive. “I think of this like physicians instructing women to take prenatal vitamins to decrease birth defects,” Borges says. “If we could prescribe a postnatal pill to take while nursing or just after a woman finishes nursing to reduce this high-risk breast cancer, that would be the goal.” About 100 women already have offered to help, but Borges says the trial would benefit from 100 more. “I’ve been overwhelmed by the community engagement,” Borges says. “Colorado women have so far stepped up to the plate and said, ‘You bet we can do this.’?” —LBK

Get Involved
If you’re interested in participating, review the trial requirements before calling 303-724-6077.

  • Participants must be 45 years old or younger
  • Participants must be pregnant or nursing
  • Participants must never have been diagnosed with breast cancer
  • Participants cannot have any autoimmune disorders or bleeding risks

Old School

DU focuses studies on the elderly

University of Denver’s much-anticipated Knoebel Center for the Study of Aging will ramp up this September, when newly hired director Lotta Granholm-Bentley arrives in Denver. The center, which has been in the works since 2010, will be housed in a currently under-construction building slated to open in summer 2016. In the meantime, Granholm-Bentley will begin the tasks of hiring a grant writer and a program coordinator and schmoozing research and business partners. We asked her—along with DU chancellor Rebecca Chopp—to list a few of the ways that they envision the center will educate students and benefit the community.

  • Granholm-Bentley wants the center to ultimately offer a minor in gerontology (the study of the social, psychological, cognitive, and biological aspects of aging). “We want our law students, engineering students, social work majors, and business students to have a broad-based knowledge on the issues of aging,” Granholm-Bentley says. “With America’s aging population, we’re going to need specialists in elder law and engineers working on assistive technologies for those who can’t get around as easily anymore.”
  • A huge focus of the center will be research on the biology behind aging. Partnering with local institutions such as Denver Health and the Colorado Neurological Institute will allow the Knoebel Center to delve into diseases of aging like dementia. “But we will also be looking at healthy aging,” Chopp says. “There’s a huge segment of those who are 65-plus who are not in poor health. Aging is not a medical problem to be solved, it’s a stage of life to be enriched.”
  • Chopp and Granholm-Bentley want the center to attract Denverites looking for resources—on how to help an aging parent live alone, on what state law says about powers of attorney, on residential communities for the elderly. “We want the center to bring more people who are 65 and older to the campus,” Chopp says. “This place can be a gateway between the community and DU.” —LBK
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Anti-Bacterial Agent

A $5 million NIH grant is funding one local physician-scientist’s war on drug-resistant bugs.

We’ve all been there: sore throat, fever, headache. All we want from the doctor is a script for some antibiotics, but he won’t write one without a throat swab. His reason: Using an antibiotic when one isn’t necessary results in drug-resistant bacteria. In that moment, it feels like the doc is torturing you, but he might be doing humanity a serious favor. “Over the past handful of years, I’ve noticed my antibiotic armamentarium has been decreasing by the day,” says Dr. Connie Price, chief medical officer and infectious disease physician at Denver Health. “Bacteria are figuring out ways to render our antibiotics useless.”

That’s not good news for anyone, but it’s a particularly nasty threat for vulnerable populations, such as those in hospitals or long-term-care facilities, places where a class of organisms called enterobacteriaceae is becoming resistant to our conventional antibiotics as well as our broad-spectrum medicines. “This is a common class of bacteria,” Price says. “It’s one of the most common causes of infection in the urinary tract, in the abdomen, in the lungs, in the blood—and it was historically predictable and easy to treat. Not anymore.”

The issue at hand, according to Price, is a survival-of-the-fittest scenario. Carbapenem-resistant enterobacteriaceae (CRE)—carbapenems are a potent class of antibiotics—are adept at thriving in places where antibiotics are used most. “In settings like hospitals and nursing homes, it becomes advantageous to these bacteria to become resistant to antibiotics because that’s the biggest threat,” Price says. “The ones that aren’t resistant die, and then we’re left with the ‘fittest’ organisms, which then spread.”

The problem is compounded by the fact that when patients are sick in the ICU, doctors are forced to use antibiotics without first knowing if the drug will help or hurt—or simply be ineffective and contribute to resistance. “Per convention,” Price says, “we wait two or three days for a bacteria to grow so we can be better informed about treating a patient.” That’s an inordinate amount of time for an ill person to wait. “We needed to decrease that time from days to hours,” Price says. So, in collaboration with Arizona-based Accelerate Diagnostics, she is trying to do just that with a five-year, $5 million grant awarded in early 2015 by the National Institutes of Health.

In February, Price began collecting samples and using Accelerate Diagnostics’ special computer software and digital microscope to localize a tiny amount of bacteria and then watch as the organisms are subjected to different treatments in order to find out what works and what doesn’t—all in about five hours. It sounds easier than it is in practice. “We’re still working on how to concentrate the specimen,” Price says, “and thinking about how this can be a cost-effective solution.” But Price says she believes the technology, if successful, will pay dividends over time. Not only would rapid diagnoses benefit the bottom line—after all, keeping a patient in the ICU can exceed six figures in a matter of days—but the technology could also help health-care facilities isolate resistant-bacteria-infected patients while simultaneously decreasing the overuse of antibiotics. “Right now we’re focusing on drug-resistant bacteria in hospital settings,” Price says, “but possibly, in the future, this technology could be adapted and used in a physician’s office. Wouldn’t it be nice if you didn’t have to convince your doctor you needed that antibiotic?” Yes, yes it would. —LBK

Overruns In Aurora

The new Veterans Affairs hospital is (way) over budget and past deadline.

Getty Images

For the past six years, Artie Guerrero has periodically driven from his Jefferson County home to Aurora so he can look at the site of what is perhaps the biggest embarrassment in the U.S. Department of Veterans Affairs’ history. “It’s such a slap in the face,” says Guerrero, a Vietnam War combat veteran who was shot three times and suffered a grenade-shrapnel wound. “People should feel ashamed about what’s happened here.”

Initially promised as a gold standard of care for veterans, the new, 182-bed Veterans Affairs hospital in Aurora has turned into a writ-large example of government incompetence. In short: There was a mega-breakdown between the firms designing the hospital and the construction contractor, who was brought on too late in the game. There was also a lack of oversight by VA officials. Originally estimated at $328 million to build, the facility’s price tag has skyrocketed to $1.7 billion—making it one of the world’s costliest hospital projects. (For reference, the per-bed cost at University of Colorado Hospital, which broke ground in 1999 and continues to add space, currently stands at $1.7 million; the VA’s cost is about $9.5 million per bed.) A spate of overruns—from doors that cost $1,400 each to a $100 million atrium—triggered congressional hearings, a shutdown, and threats of another work stoppage if Congress fails to approve $830 million more for the project. Although it was originally supposed to open in 2014, the hospital’s earliest opening date is now scheduled for sometime in 2017.

Veterans who use the VA’s current 64-year-old hospital, located near the corner of East Ninth Avenue and Colorado Boulevard in Denver, have endured substandard conditions for decades, making demand for a new facility even more desperate. Along with a barrage of complaints about overcrowding, vets have reported bad plumbing, operating-room shutdowns, and power outages. Sadly, the debacle in Aurora is hardly the only place the VA has failed: Cost overruns and construction delays have marred other hospital projects in Las Vegas, New Orleans, and Orlando, Florida.

Guerrero has been among Colorado’s most outspoken veterans when it comes to the VA’s failures. He worries the state’s 460,000 veterans will never see a new hospital—or, if they do, it’ll be one that won’t serve their needs. “This is about quality medical care for those who served this country,” he says. “Forty-eight years after paying the price, coming home, and fighting this system, it’s like nothing has changed.” —Robert Sanchez

The approximate percentage decrease in Colorado’s teen pregnancy rate between 2009 and 2013. This drop might be attributed, in part, to expanded access to and education about long-acting reversible contraception (LARC), such as birth control injections and implants and intrauterine devices. (Private funding has provided the state with $5 million per year since 2009 to increase access to LARC at federally funded Title X clinics.)

According to Mary Jane Cassalia, a youth health specialist with the Colorado Department of Public Health and Environment, more than a quarter of teens in Colorado Title X clinics choose a LARC method. That’s the highest rate in the country. Colorado’s state-mandated, commonsense approach to sex education may have something to do with the drop in teen pregnancy, too. In 2013, the Legislature reinforced a statute requiring schools to provide “evidence-based, culturally sensitive, medically accurate, age-appropriate” sex ed addressing abstinence and contraception. Little wonder our teens rank third in the country for condom use. —KC

Illustration by Harry Campbell

Brain Strain

A promising study out of CU will deliver results on dementia this fall.

Dr. Huntington Potter could talk about the brain and dementia for long enough to stage a filibuster. After all, the director of the Rocky Mountain Alzheimer’s Disease Center at the University of Colorado Anschutz Medical Campus has spent 20 years propelling our understanding of the neurodegenerative disease forward in an endeavor to reach a cure for 5.3 million Americans—a number that’s expected to more than triple in the next 35 years.

Potter’s most recent effort is based on a well-known piece of information in the Alzheimer’s research community: People with rheumatoid arthritis (RA) rarely develop Alzheimer’s disease. Potter, along with colleague Dr. Tim Boyd, found that a specific protein (called granulocyte-macrophage colony-stimulating factor, GM-CSF) protects those with RA from developing dementia by telling certain cells to chew up unnecessary beta-amyloid protein fragments in the brain. Previous research determined that the buildup of these beta-amyloid fragments causes the formation of “plaques,” which block connections between synapses, leading to neuron death and reduced cognitive functioning. When mice carrying human Alzheimer’s genes were injected with GM-CSF for one week, the beta-amyloids in their brains were cut in half. “It was the fastest, most effective reduction anyone had seen,” Potter says.

By this fall, Potter and his team will wrap up a two-site clinical trial with 40 human patients with mild to moderate Alzheimer’s disease (half here, half in Tampa, Florida). The patients are injected with Leukine, an FDA-approved leukemia drug that’s the man-made version of GM-CSF, five times a week for three weeks. If the test run is deemed safe and successful at lowering beta-amyloid buildup in patients’ brains, the next step will be raising approximately $4 million for an extended six-month trial. Which is really nothing compared to the $226 billion the United States will spend caring for dementia patients this year alone. —DS

OTC Medicine
Three unexpected actions you can take to reduce your risk of developing dementia.

  • Drink three to five cups of coffee every day. Studies have shown a correlation between caffeine and sustained cognition, which means you now have a good excuse for spending that $4 at Starbucks.
  • Exercise. It really does help with everything. According to the Mayo Clinic, early studies have shown that physically active people are “less likely to experience a decline in their mental function and have a lowered risk of developing Alzheimer’s disease.”
  • “Keep your friendship levels and general cognitive stimulation high,” Potter says. In studies, enriched environments—like well-populated cages outfitted with lots of toys—have kept mice from developing Alzheimer’s.